Antibiotics for respiratory, ear and urinary tract disorders and consistency among GPs

To describe specific diagnoses for which systemic antibiotics are prescribed, to assess adherence of antibiotic choice to national guidelines and to assess consistency among general practitioners (GPs) in prescribed volumes of antibiotics for respiratory, ear and urinary tract disorders.

The cross-sectional study included 174 GPs from 89 general practices. Data were derived from the Second Dutch National Survey of General Practice (DNSGP-2) in 2001. Outcome measures were the antibiotic prescriptions for respiratory, ear and urinary tract disorders defined according to the International Classification of Primary Care codes, the percentage of first-choice antibiotics complying with national guidelines and the number of antibiotic prescriptions per 1000 patients per GP per year.

The most antibiotics for respiratory tract infection (RTI) were prescribed for acute bronchitis (25%), sinusitis (22%) and acute upper RTI (14%). The most antibiotics were prescribed for acute otitis media (77% of ear disorders) and cystitis (95% of urinary tract disorders). First-choice antibiotics were prescribed in approximately 75% of the cases, whereas macrolides and amoxicillin/clavulanate (second-choice antibiotics) were prescribed in approximately 25%, especially in lower RTIs. The correlations (Spearman rho) between prescribed volumes for the three main groups of disorders varied from 0.39 to 0.67.

GPs were consistent in prescribing antibiotics for the three groups of diseases. Improvement strategies should focus on the management of acute upper RTIs and acute bronchitis and also on the use of amoxicillin/clavulanate and macrolides, these being mostly second-choice antibiotics in national guidelines.